Health. Home & Family

Severe Morning Sickness – Hyperemesis Gravidarum (HG)

This week we have an article on severe morning sickness/hyperemesis gravidarum shared with us by Miriam Erick from Boston, Massachusetts U.S.A. Erick is a Registered Dietitian/nutritionist and author of ‘Managing Morning Sickness: A Survival Guide for Pregnant Women’ and ‘Take Two Crackers and Call Me in the Morning! A Real-Life Guide for Surviving Morning Sickness.’ Erick has had her work on HG published in the UK journal -Medical Hypotheses and the American Journal of Medical Genetics. Please feel free to share your comments on this article.

The announcement regarding an upcoming international Hyperemesis Gravidarum (HG) Awareness Day 2015 was discovered incidentally by Registered dietitian/nutritionist and morning sickness book author, Miriam Erick, getting computer lessons by business consultant Ed Bartley in Newton, Massachusetts. Instantly, plans to convene a “HGAD” began when Erick reviewed the Meet UP List: few dozen US cities and a locale in Spain were listed but not Boston.

As a result, a small but seriously determined group of severe morning sickness/hyperemesis gravidarum survivors convened in a Meet Up Group on cool gray Saturday afternoon on May 16, 2015, at Fresh City in Newton, Massachusetts. While the all-male wait staff at Fresh City had no idea about HG at all, they graciously and attentively supplied commentary iced tea and iced coffee to the HERS contingent. The HERS (Hyperemesis Education and Research and Support) Foundation logo was prominent signage at the entryway in Fresh City to announce the event and the Fresh City group received a crash course in the problem of HG.

Ironically and only recently has the average person known severe nausea and vomiting of pregnancy, known medically as hyperemesis gravidarum exists. This old Greek terminology confuses many. Way too technical and way too difficult to pronounce is the consensus of opinion. [“hyper” means “a lot”. “emesis” means vomit. “gravid” means pregnant woman] As dehydration in any situation is life-threatening—so does HG present the same critical life-threatening problem.

This is what many people learned in December 2012 when nightly newscasts and the world’s tabloids blasted news the wife of Prince William, the first born son of the late Princess Diana and Prince Charles, that the Duchess of Cambridge, gracious, svelte and always smiling, Kate Middleton, was ill because of pregnancy. The collective inquiring public mind wanted more news about the Royal sickness. However the world heard none of the gory details about what life as a woman with HG entails.

“HG is never a pretty picture. Intervention is not consistent: however the problem basically is the same: starvation in pregnancy” quips Erick. She recounts this age-old problem of severe nausea and vomiting of pregnancy has existed for hundreds of years and caused the death of countless numbers of women including the celebrated author, Charlotte Bronte, in 1855. Estimates are 60,000 US women are hospitalized annually. Statistics about hospitalizations for HG from other countries are not easy to access. Morbidity and mortality from HG are significant for both the mother and the fetus/baby in severe cases. Erick cites a case of vitamin K embryopathy in a child of an HG mom she cared for who was included in a case series by Toriello HV et al published in the American Journal of Medical Genetics in 2013.

“There also cognitive changes associated with severe HG—the most severe being Wernicke’s encephalopathy (WE) which is characterized by memory loss, difficulty walking and muscle failure- especially those associated with eye-movements. Wernicke’s is most often expected and associated with alcoholism but there are over 100 cases of WE and HG in the medical literature, “ she recites.

Alicia and Nicholas with Katarina Mollo

“In situations where the eventual diagnosis of WE is made in an HG case, serious physical and cognitive damage has accrued” Erick reflects.

Erick wonders if the early stages of starvation-related cognitive decline manifest as horrific nightmares, hallucinations which she hears often from sick women. When sick pregnant women begin to think either of abortion and/or suicide, this might be a pre-clinical form of WE. WE is a subtle problem, occurring in patients with a prolonged course of illness and especially very poor nutritional intake. In a demanding patient who is very frustrated with ineffective interventional care, symptoms are blurred. Many cases do not present with the classic teaching of the trilogy: nystagmus- eyes are rotating uncontrollably, memory loss, and ataxia–walking difficulty.

“What is common in just about every paper about WE— is malnutrition! No food for the muscles and no food for the brain—that’s the common element,” she says.

One of Erick’s sickest HG women returned for a postpartum visit and shared an occurrence not divulged during her 9 months of HG hell— seeing images and hearing noises no one else did. As a new mom with a precious daughter, this woman felt free to share her horrors hoping to be able to help other women. Armed with new information, Erick put pen to paper and wrote “Hyperemesis gravidarum: a case of starvation and altered sensorium gestosis (ASG)” which was published in the prestigious UK publication, Medical Hypotheses in May 2014.

Based on her clinical experience working on an obstetrical unit at a major Boston teaching hospital and encounters with sick women since the publication of her first book on morning sickness in 1993, “No More Morning Sickness: a survival guide for pregnant women” Erick knew HG women needed to talk about their ordeals.

Heather and Vivian

One woman at the HGAD event was a two-time hero of HG, changing providers for her second pregnancy. Women were struggling with the decision to have a second child; aware that weeks of physical and economic disability, weight loss and malnutrition would likely re-occur. Constant nausea and frequent daily vomiting despite medication, weight loss, visits to emergency rooms for intravenous fluids were far from the joys of impending motherhood the majority of pregnant women experience.

“If Duchess Kate becomes a serious spokesperson for HG—the world collectively would “OMG!” one Fresh City participant offered. Historical thinking, originating in 1892, suggested HG was a form of psychological rejection of pregnancy. Another participant doubted if anyone asked Kate she really wanted to have a baby. “That person would have instantly been canned—and rightly so for such an audacious question! However.. that innuendo was directed at me—more than once” she volunteered.

Erick shared she asked her publisher in 2012, Bull Publishing in Boulder, Colorado to send the Duchess a copy her book, “Managing Morning Sickness” which was dispatched immediately. While working on an electronic version of “Take Two Crackers and Call Me in the Morning! A real-life guide to surviving morning sickness” Erick then decided to send the suffering Kate a hard copy of the original project. Weeks later Erick was most pleasantly surprised to receive a “thank you” note from St. James’ Palace. Erick’s current literary venture is an e-book “Take Two Crackers and Call Me in the Morning! A real-life guide for surviving morning sickness” scheduled for early June 2015 release.

Erick follows HG issues closely and reports an October 2015 international HG conference is scheduled to convene in Bergen, Norway and will include world-renown researchers sharing their findings and expertise. Interested persons can google “No Hype”, the Norwegian Hyperemesis Initiative for more information.